eMedicine Specialties > Emergency Medicine > Infectious Diseases
Herpetic Whitlow: Treatment & Medication
Updated: May 27, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Emergency Department Care
- Herpetic whitlow is a self-limited disease. Treatment most often is directed toward symptomatic relief.
- Acyclovir may be beneficial.
- In primary infections, topical acyclovir 5% has been demonstrated to shorten the duration of symptoms and viral shedding.
- Oral acyclovir may prevent recurrence. Doses of 800 mg twice daily initiated during the prodrome may abort the recurrence.5
- Use antibiotic treatment only in cases complicated by bacterial superinfection.
- Tense vesicles may be unroofed to help ameliorate symptoms, and wedge resection of the fingernail may be used for the same purpose in cases involving the subungual space.
- Deep surgical incision is contraindicated, since this may lead to delayed resolution, bacterial superinfection or systemic spread, and complications such as herpes encephalitis.
Medication
The main goals of treatment are to prevent oral inoculation or transmission of infection and to provide symptomatic relief.5
Antiviral agents
These agents are used to shorten the clinical course, prevent complications, prevent the development of latency and/or subsequent recurrences, decrease transmission, and eliminate established latency.
Acyclovir (Zovirax)
Topical form shortens duration of symptoms in primary infections; acts by interfering with DNA replication within the virions.
Oral acyclovir may abort recurrences if treatment is initiated immediately upon onset of symptoms; inhibits HSV-1 and HSV-2.
Adult
600-800 mg PO q4h for 7-10 d
Immunocompromised adults: 800 mg PO q4h, 5 times per d for 7-10 d
Topical: Apply 0.5-inch ribbon of ointment for a 4-in2 surface area q3h, 6 times per d for 7-14 d
Pediatric
250-600 mg/m2/dose PO 4-5 times per d for 7-10 d
Topical: Administer as in adults
Concomitant use of probenecid or zidovudine prolongs half-life and increases CNS toxicity of acyclovir
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in renal failure or when using nephrotoxic drugs
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References
Wu IB, Schwartz RA. Herpetic whitlow. Cutis. Mar 2007;79(3):193-6. [Medline].
Klotz RW. Herpetic whitlow: an occupational hazard. AANA J. Feb 1990;58(1):8-13. [Medline].
Robayna MG, Herranz P, Rubio FA, Pena P, Pena JM, Gonzalez J, et al. Destructive herpetic whitlow in AIDS: report of three cases. Br J Dermatol. Nov 1997;137(5):812-5. [Medline].
El Hachem M, Bernardi S, Giraldi L, Diociaiuti A, Palma P, Castelli-Gattinara G. Herpetic whitlow as a harbinger of pediatric HIV-1 infection. Pediatr Dermatol. Mar-Apr 2005;22(2):119-21. [Medline].
Nikkels AF, Pierard GE. Treatment of mucocutaneous presentations of herpes simplex virus infections. Am J Clin Dermatol. 2002;3(7):475-87. [Medline].
Weisman E, Troncale JA. Herpetic whitlow: a case report. J Fam Pract. Nov 1991;33(5):516, 520. [Medline].
Further Reading
Keywords
herpetic whitlow, herpetic infection, hand infection, herpes simplex virus, HSV-1, herpes simplex virus 2, HSV-2, infection of the hand, infection of the finger
Treatment & Medication: Herpetic Whitlow